胫骨截骨骨搬运联合含万古霉素骨水泥垫块填充治疗胫骨外伤后骨感染伴软组织缺损的效果

Effect of tibial osteotomy and bone transport combined with vancomycin-containing bone cement pad filling on treatment of tibial trauma patients with bone infection and soft tissue defects

目的探讨胫骨截骨骨搬运联合含万古霉素骨水泥垫块填充治疗胫骨外伤后骨感染伴软组织缺损的效果。方法回顾性分析2019年1月-2023年6月龙游县人民医院骨科接受胫骨截骨骨搬运联合含万古霉素骨水泥垫块填充治疗的82例胫骨外伤后骨感染伴软组织缺损患者临床资料,根据患者治疗意愿不同分为A组(胫骨截骨骨搬运联合含万古霉素骨水泥垫块填充治疗)33例和B组(单独胫骨截骨骨搬运术治疗)49例。比较两组临床疗效、骨搬移软组织愈合时间、外固定时间、搬移区矿化时间、骨延长长度、外固定指数和术后24个月的美国膝关节协会膝关节功能(AKS)评分、Baird-Jackson评分、骨感染复发率及并发症发生率。结果术后24个月,A组疗效率高于B组(P<0.05);A组骨搬移软组织愈合时间、外固定时间和搬移区矿化时间均短于B组,骨延长长度长于B组,外固定指数则高于B组(P<0.05);术后24个月,A组AKS评分和Baird-Jackson评分均高于B组,骨感染复发率则低于B组(P<0.05);A组术后总并发症发生率为9.09%,低于B组的30.61%(P<0.05)。结论胫骨截骨骨搬运联合含万古霉素骨水泥垫块填充治疗可促进胫骨外伤后骨感染伴软组织缺损患者骨延长、软组织愈合和膝踝关节功能恢复,降低感染复发风险。

OBJECTIVE To explore the effect of tibial osteotomy and bone transport combined with vancomycin-containing bone cement pad filling on treatment of the tibial trauma patients with bone infection and soft tissue defects.METHODS A total of 82 tibial trauma patients with bone infection and soft tissue defects who were treated with tibial osteotomy and bone transport combined with vancomycin-containing bone cement pad filling in Longyou County People′s from Jan.2019 to Jun.2023 were enrolled in the study and were divided into the group A with 33 cases(treated with tibial osteotomy and bone transport combined with vancomycin-containing bone cement pad filling)and the group B with 49 cases(treated with single tibial osteotomy and bone transport)according to the wishes of the patient.The clinical data of the enrolled patients were retrospectively analyzed.The clinical curative effect,healing time of bone transport soft tissues,duration of external fixation,mineralization time of transport area,extended length of bone and external fixation indexes were compared between the two groups.The American knee society clinical rating system(AKS)score,Baird-Jackson score,recurrence rate of bone infection and incidence of complications were compared between the two groups after the surgery for 24 months.RESULTS After the surgery for 24 months,the effective rate of treatment of the group A was higher than that of the group B(P<0.05).The healing time of bone transport soft tissues,duration of external fixation and mineralization time of transport area were shorter in the group A than in the group B,the extended length of bone of the group A was longer than that of the group B,and the external fixation indexes of the group A were higher than those of the group B(P<0.05).After the surgery for 24 months,the AKS score and Baird-Jackson score were higher in the group A than in the group B,while the recurrence rate of bone infection of the group A was lower than that of the group B(P<0.05).The total incidence of postoperative complications of the group A was 9.09%,lower than 30.61%of the group B(P<0.05).CONCLUSION The tibial osteotomy and bone transport combined with vancomycin-containing bone cement pad filling can promote the bone extension,healing of soft tissues and recovery of knee and ankle function of the tibial trauma patients with bone infection and soft tissue defects,and it can also reduce the risk of recurrence of infection.